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Ask Dr. Hallberg: Cholera in Haiti

Health officials in Haiti continue their efforts to curb the spread of cholera. An outbreak there has already taken the lives of more than 300 people, and cases have been confirmed in two new areas of the country.

Cholera outbreaks in Pakistan and Nigeria have also been reported in recent days.

Hallberg is a physician in family medicine at the University of Minnesota and medical director of the Mill City Clinic in Minneapolis.

[[header:Tom Crann: Give us the basics on cholera. What is it and how is it spread?

[[header:Dr. Jon Hallberg: Cholera is a bacteria. It's called Vibrio cholerae, and it's a very interesting bacteria in that it has a little flagella, little tail that helps it swim upstream and attach to the intestinal wall where it does its damage. And it's spread the way that most diarrheal illnesses are spread, and that is by consuming sewage-tainted water.

[[header:Crann: The water gets contaminated with the bacteria.

[[header:Hallberg: That's right.

[[header:Crann: And how infectious is it?

[[header:Hallberg: Well, it's interesting. They think that about seventy-five percent of the people who get exposed to this bacteria do not develop any symptoms at all, and that's because we have hydrochloric acid in our stomach. And it's acidic enough that it can kill the bacteria as it enters the body, so thank goodness for that. Then, of the people who get diarrhea, we think about eighty percent get mild or moderate disease, non-life threatening disease. So that leaves about twenty percent of the people who show symptoms and they're the ones that we're hearing about that are dying at times.

[[header:Crann: Why is cholera so deadly?

[[header:Hallberg: Unlike all the other germs that cause diarrhea that may cause inflammation or may make it harder for the intestine to re-absorb water, cholera opens the flood gates. There's an outpouring of water in a way that's absolutely extreme. I mean it's literally actively pulling fluid out of the bloodstream, and you just can't survive very long if that's going on. People can lose up to ten liters of fluid a day, and if that's happening, that's not compatible with life. You're going to get dehydrated. Your electrolytes are going to be out of balance and death can ensue.

[[header:Crann: Very quickly.

[[header:Hallberg: Very quickly, within hours sometimes.

[[header:Crann: So, how is it treated? If it's a bacteria, I'm thinking antibiotics.

[[header:Hallberg: Exactly, and you can use antibiotics, but that is not the first line of treatment. It seems so simple, but the idea is: if you get this, you need to replace the fluids that you're losing. So what you do is you take a packet that has sodium and potassium and chloride and sugar, and you mix it in a liter of water. It's sort of like Pedialyte or Gatorade, but costing pennies a packet. And you simply give that to the person who's having the symptoms, and you keep giving it until the symptoms run their course. And it's as simple as that. That's incredibly life saving. It's just a matter of getting the packets to the people who need it and getting them the clean water in which to mix it.

[[header:Crann: Protesters in Haiti apparently are so worried about the spread of this disease that they've rioted, thrown rocks at a clinic that was opening. Are those concerns warranted?

[[header:Hallberg: Cholera and bubonic plague, in historical context, have sparked such fear and anxiety. I mean this goes back hundreds of years. There are major, major pandemics of cholera in the 1800s that would come with waves through Europe and the United States and other countries around the world. And I think it's almost like in our DNA that when you hear that there's a cholera outbreak, people are just so afraid.

[[header:Crann: It's hysteria over the disease because they see how destructive it is to people?

[[header:Hallberg: Absolutely. I mean to see someone die within hours of a disease - there are very few diseases that cause that kind of death on such a broad scale.

[[header:Crann: We're hearing that it was not very common and it was thought to be all but eradicated on the island which Haiti shares with the Dominican Republic. What does it take for it to reappear the way it has?

[[header:Hallberg: Almost in every case today, when you mentioned Pakistan and Nigeria, it's displacement of people. When you've had war or famine or earthquakes and sewage systems are disrupted and people are living in camps and there's no way to ensure that the water that they're consuming is clean, it's a perfect setup for this kind of thing. So, the fact that it's happening tells us that cholera probably did exist on some low-grade level in Haiti. It was never fully eradicated. We were worried after (Hurricane) Katrina that New Orleans would experience cholera, and it didn't, because cholera isn't here in this country.

[[header:Crann: It was eradicated because of what? What's the number one thing that kills it off?

[[header:Hallberg: It's just simply having a good working sewage system. If we consume clean water that's free of any bacteria ... like this, you can basically eradicate it.